Went to my PCP to do some tests due always being tired, lack of energy, low libido and its getting very hard to maintain an erection. I am 43 years old and i have been noticing these symptoms to be getting worse as time goes by. PCP prescribed three injections, one every two weeks, i belive 200MG testosterone cypionate, and told me to see how i felt after the three shots. She said there is no standard number, some people feel good with my levels and some people dont and need it higher. Please share your advise ont his.
I did not do well on 1x per week, and I cannot imagine anyone doing well on cypionate every 14 days. I would aim for at least 1 shot per week. I am at M/W/F right now (30/30/40 mg) and doing very well on it.
Crop out your personal info and dont do this 200 mg every two weeks protocol.
75-100 mg/week either once or twice weekly injections to start. Follow up with bloodwork in 6 weeks and go from there.
Total T is not comprehensive enough of a measurement to start TRT. Get TT, FT, E2, FSH, LH, and SHBG at a minimum. You can only diagnose secondary or primary hypo issues before starting exogenous testosterone.
You should have done more research because so many doctors are following outdated guidelines.
Get off this hormonal roller-coaster protocol and get on a modern TRT protocol or go on Jatenzo.
These every two week protocols give you supraphysiological levels the first week, then levels can drop low leaving you hypogonadal for the second week.
This protocol can also drive hemoglobin and hematocrit sky high over time, creating multiple headaches that force a blood donation which can then halve your ferritin levels.
These protocols are ancient and obsolete.
I would do what @readalot suggested.
OK, these other posts are not necessarily wrong. However, you need to change doctors. Not particularly because of what she is recommending, most patients PCPs put on testosterone do fine on twice monthly dosing and are happy with it. Does not mean I would use twice monthly or agree with it. I have zero patients injecting twice monthly. I would use once or twice weekly.
The reason you should change doctors is you do not have confidence in her. It is what it is. You consulted with your doctor, she was willing to try to help you when many GPs would not, and it sounds as though she has some experience with TRT. Before even waiting to see how you would respond, you go on the internet looking for advice. I could understand it if you’ve been on testosterone for months with no improvement or side effects.
That’s OK though, you can’t help they way you feel. Personally, I’ve had a couple patients do that to me. It’s not going to go well three weeks in. I’m telling that person to decide who they want to be their doctor, me or the internet. Been there, done that. Other circumstances, long term patient with a unique idea, maybe less than ideal results, I’ll listen.
You asked for advice. If you are considering staying with her, do not tell her what you’ve read here. Follow your prescription. What probably everyone on this forum fails to realize is that thousands, hundreds of thousands actually, are sourcing TRT through GPs, UROs or ENDOs and on a twice monthly dosing schedule. I meet these men all the time. They find out what I do for a living. The conversation goes on and at some point I’ll ask them how they like testosterone and their dose and schedule. They are mostly very happy. Could it be better? Maybe? I’m not going there if they are happy, what kind of asshole would I look like doing that?
If you are not doing well, have the conversation after six weeks. Maybe question her regarding more frequent dosing, different dose, whatever. See what her thoughts are. Six weeks, not now.
If, after doing your research, you decide to make a change, do it now.
You might be happier with a TRT practice. Good luck, hope it works it.
Stop being reasonable!
The reason i posted is not that i dont trust her, but at the end of the day she is not an Endo, and the lack of information i have about testosterone
Took me here to get as much info as i can, not to dispute her, but to gain knowledge and have resources if it comes the time i need to change my plan based on her recommendations, as i see it there is no exact protocol for everyone, and above all things i want to be as safe as possible injecting a hormone in my body. What i do know is an informed patient is better off for both patient and doctor. I really appreciate the time you took to answer.
So basically the test i posted is not complete in order to prescribe TRT ??
Technically you are on the fence but if you really want to learn (while you have the chance) would do as @blshaw states.
TT by LC/MS-MS
fT by equilibrium dialysis
You could also consider running hCG/AI/SERM monotherapy first based on what you find with your complete testing. Also there is Natesto/nasal gel/troches so you can run a little testosterone test without shutting down your HPTA fully.
You require two separate tests showing low-T in order for your insurance to cover therapy.
I never had LH and FSH tested prior to TRT. The LH and FSH only tell you if you have secondary or primary hypogonadism. Whether you test LH or not, it doesn’t change the fact you have low-T.
Don’t expect much different from them.
Yes, welcome to the TRT world.
Of course, agreed. I encourage patients to do some research, talk to others, etc. Also, beware, the quality and accuracy of the information is a factor in this process. One of the reasons I am here is because I want to know what they are reading. Then, I can address and explain some of it prior to them stumbling on it.
What is the best forum you peruse for TRT/HRT?
You have a top 3 or 5?
I do agree on your second and third point, on the first one i can not either agree nor disagree, i have never been to one. But i totally see your point in your first reply to my post.
In network? That will be a good learning experience for you.
good reference point for baseline pituitary function if you ever want to come off and recover. Baselines always underappreciated until you wish you had one.
Better to have and not need than…
well insurance covered at least the three shots, i had to pay around $15.00 for all three, what it did not cover were the syringes
i had not gone to the doctor in about 3 years, main reason i went is i have been feeling weaker and weaker as years go by, also my libido has gone down the drain, so besides a complete CBC, urinalisis and what not, she also tested testosterone.
Sounds like a nice Doc. You should work with her using the above info. More open minded than a lot of PCPs. Congrats.
hey man i really appreciate every one who contributed to my post. I will definitely keep her for now. She said after covid she has had a lot of patients with lower than normal testosterone for their age, maybe another crazy aftermath from Covid, or not ??
Forgot to add, my vitamin D came at 21. Harvard recommends at least 30
So thats another thing i need to work on.